| ICD-10 | R00.2 |
|---|---|
| ICD-9 | 785.1 |
| DiseasesDB | 29231 |
| MedlinePlus | 003081 |
| eMedicine | aaem/337 |
A palpitation is an abnormal awareness of the beating of the heart, whether it is too slow, too fast, irregular, or at its normal frequency. A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from A Sign is an indication of some fact or quality and a medical sign is an objective indication of some medical fact or quality that is detected by a Physician The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings R00-R69 - Symptoms and Signs (R00-R09 Circulatory and Respiratory systems ( Abnormalities of Heart beat The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Measuring heart rate The Pulse rate (which in most people is identical to the heart rate can be measured at any point on the body where an Artery 's pulsation The heart is a muscular organ in all Vertebrates responsible for pumping Blood through the Blood vessels by repeated rhythmic The difference between an abnormal awareness and a normal awareness is that the latter is almost always caused by a concentration on the beating of one's heart and the former interrupts other thoughts. Palpitations may be brought on by overexertion, adrenaline, alcohol, caffeine, disease (such as hyperthyroidism) or drugs, or as a symptom of panic disorder. Caffeine is a bitter white crystalline Xanthine Alkaloid that acts as a Psychoactive Stimulant Drug and a mild Diuretic A disease is an abnormal condition of an organism that impairs bodily functions and can be deadly Hyperthyroidism is the term for overactive tissue within the Thyroid gland resulting in overproduction and thus an excess of circulating free thyroid hormones Thyroxine Panic Disorder is a Psychological condition characterized by recurring Panic attacks in combination with significant behavioral change lasting at least a month More colloquially, it can also refer to a shaking motion. It can also happen in mitral stenosis. Mitral Stenosis is a Valvular heart disease characterized by the narrowing of the orifice of the Mitral valve of the Heart.
Nearly everyone experiences an occasional awareness of their heart beating, but when it occurs frequently, it can indicate a problem. Palpitations may be associated with heart problems, but also with anemias and thyroid malfunction. Anemia ( AmE) or anæmia/anaemia ( BrE) (from the Ancient Greek grc-Latn anaîmia, meaning “without blood” is defined as a qualitative The thyroid is one of the largest Endocrine glands in the body
Attacks can last for a few seconds or hours, and may occur very infrequently, or more than daily. Palpitations alongside other symptoms, including sweating, faintness, chest pain or dizziness, indicate irregular or poor heart function and should be looked in to.
Palpitations may also be associated with anxiety and panic attacks, in which case psychological assessment is recommended. This is a common disorder associated with a lot of common medications such as anti-depressants.
Contents |
Causes of palpitation
Palpitations can be attributed to one of three main causes:
1- Hyperdynamic circulation (Valvular Incompetence, Thyrotoxicosis, Hypercapnia, Pyrexia, Anemia, Pregnancy. Hyperthyroidism is the term for overactive tissue within the Thyroid gland resulting in overproduction and thus an excess of circulating free thyroid hormones Thyroxine Hypercapnia or hypercapnea (from the Greek hyper = "above" and kapnos = " Smoke " also known as hypercarbia is Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris Anemia ( AmE) or anæmia/anaemia ( BrE) (from the Ancient Greek grc-Latn anaîmia, meaning “without blood” is defined as a qualitative Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female . . )
2- Sympathetic overdrive (Panic disorders, Hypoglycemia, Hypoxia, Levocetirizine antihistamines, Anemia, Heart Failure, Mitral valve prolapse. Panic Disorder is a Psychological condition characterized by recurring Panic attacks in combination with significant behavioral change lasting at least a month Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of Glucose ( sugar) in the blood Chronic Hypoxia is a pathological condition in which the body as a whole ( generalized hypoxia) or region of the body ( tissue hypoxia) is deprived of adequate Levocetirizine (as levocetirizine dihydrochloride is a third generation non-sedative Antihistamine, developed from the second generation antihistamine Cetirizine A histamine antagonist is an agent which serves to inhibit the release or action of Histamine. Anemia ( AmE) or anæmia/anaemia ( BrE) (from the Ancient Greek grc-Latn anaîmia, meaning “without blood” is defined as a qualitative Heart failure is a Cardiac condition that occurs when a problem with the structure or function of the Heart impairs its ability to supply Mitral valve prolapse (MVP is a Valvular heart disease characterized by the displacement of an abnormally thickened Mitral valve leaflet into the left atrium [1]. . )
3- Arrhythmias (AF, SVT, Ventricular tachycardia, Ventricular fibrillation, Heart block. Ventricular tachycardia ( V-tach or VT) is a Tachycardia, or fast heart rhythm that originates in one of the ventricles of the Heart Ventricular fibrillation ( V-fib or VF) is a condition in which there is uncoordinated contraction of the Cardiac muscle of the ventricles in the A heart block is a disease in the electrical system of the Heart. . . )
Types of palpitation
People describe their palpitations in many different ways, but there are some common patterns:
The heart "stops"
Those who experience palpitations may have the feeling that their heart stops beating for a moment, and then starts again with a "thump" or a "bang". Usually this feeling is actually caused by an extra beat (premature beat or extrasystole) that happens earlier than the next normal beat, and results in a pause (called a Compensatory Pause) until the next normal beat comes through. Premature ventricular contraction (PVC, also known as ventricular premature beat (VPB or extrasystole, is a form of irregular heartbeat in which the People are not usually aware of the early, extra beat, but may be aware of the pause, which follows it (the heart seems to stop). The beat after the pause is more forceful than normal (due to filling with more blood than usual during the Compensatory Pause), giving the "thumping" sensation.
The heart is "fluttering" in the chest
Any rapid heartbeat (or tachycardia) can give rise to this feeling. A rapid, regular fluttering in the chest may be associated with sensation of pounding in the neck as well, due to simultaneous contraction of the upper, priming chambers of the heart (the atria) and the lower, main pumping chambers (the ventricles). If the fluttering in the chest feels very irregular, then it is likely that the underlying rhythm is atrial fibrillation. Atrial fibrillation ( AF or afib) is a Cardiac arrhythmia (abnormal heart rhythm that involves the two upper chambers ( atria) of the Heart During this type of rhythm abnormality, the atria beat so rapidly and irregularly that they seem to be quivering, rather than contracting. The ventricles are activated more rapidly than normal (tachycardia) and in a very irregular pattern.
Minor
Some people may experience what is known as a minor palpitation, where the heart feels like it skips a beat. These are generally easy to ignore, but cause the person to worry more if their symptoms have not been diagnosed by a doctor.
Types
Palpitations may be associated with feelings of anxiety or panic. It is normal to feel the heart thumping when feeling terrified or scared, but it may be difficult to know whether the palpitations or the panicked feeling came first. Unfortunately, since it can take some time before a clear diagnosis is made in a patient complaining of palpitations, people are sometimes told initially that the problem is anxiety.
Stressful situations cause an increase in the level of stress hormones, such as adrenaline, circulating in the blood, and there are some types of abnormal heart rhythm that can be stimulated by adrenaline excess, or by exercise. It may be possible to diagnose these sorts of palpitations by performing simple tests, such as an exercise test, while monitoring the ECG.
Some types of abnormal heart rhythm seem to be affected by posture. For many people, standing up straight after bending over can provoke a rapid heart rate. Often these attacks can be abolished again by lying down. Many people, if not all, are more aware of the heartbeat when lying quietly in bed at night. This is partly because at that time, the attention is not focused on other things, but also because the slower heart beat at rest can allow more premature beats to occur.
Symptoms
Many times, the person experiencing palpitations may not be aware of anything apart from the abnormal heart rhythm itself. But palpitations can be associated with other things such as tightness in the chest, shortness of breath, dizziness or light-headedness. Depending on the type of rhythm problem, these symptoms may be just momentary or more prolonged. Actual blackouts or near blackouts, associated with palpitations, should be taken seriously because they often indicate the presence of important underlying heart disease.
Diagnosis
The most important initial clue to the diagnosis is one's description of the palpitations. The approximate age of the person when first noticed and the circumstances under which they occur are important, as is information about caffeine intake (tea or coffee drinking). Caffeine is a bitter white crystalline Xanthine Alkaloid that acts as a Psychoactive Stimulant Drug and a mild Diuretic It is also very helpful to know how they start and stop (abruptly or not), whether or not they are regular, and approximately how fast the pulse rate is during an attack. If the person has discovered a way of stopping the palpitations, that is also helpful information.
The diagnosis is usually not made by a routine medical examination and electrical tracing of the heart's activity (ECG), because most people cannot arrange to have their symptoms while visiting the doctor. Nevertheless, findings such as a heart murmur or an abnormality of the ECG, which could point to the probable diagnosis, may be discovered. Murmurs are abnormal Heart sounds that are produced as a result of turbulent blood flow which is sufficient to produce audible noise In particular, ECG changes that can be associated with specific disturbances of the heart rhythm may be picked up; so routine physical examination and ECG remain important in the assessment of palpitations.
Blood tests, particularly tests of thyroid gland function are also important baseline investigations (an overactive thyroid gland is a potential cause for palpitations; the treatment in that case is to treat the thyroid gland over-activity). The thyroid is one of the largest Endocrine glands in the body
The next level of diagnostic testing is usually 24 hour (or longer) ECG monitoring, using a form of tape recorder (a bit like a Walkman) called a Holter monitor, which can record the ECG continuously during a 24-hour period. In Medicine, a Holter monitor (also called an ambulatory electrocardiography device) named after its inventor Dr If symptoms occur during monitoring it is a simple matter to examine the ECG recording and see what the cardiac rhythm was at the time. For this type of monitoring to be helpful, the symptoms must be occurring at least once a day. If they are less frequent then the chances of detecting anything with continuous 24, or even 48-hour monitoring, are quite remote.
Other forms of monitoring are available, and these can be useful when symptoms are infrequent. A continuous-loop event recorder monitors the ECG continuously, but only saves the data when the wearer activates it. Once activated, it will save the ECG data for a period of time before the activation and for a period of time afterwards - the cardiologist who is investigating the palpitations can program the length of these periods. Cardiology (from Greek grc καρδίᾱ kardiā, "heart" and grc -λογία -logia) is the branch of Internal medicine A new type of continuous-loop recorder has been developed recently that may be helpful in people with very infrequent, but disabling symptoms. This recorder is implanted under the skin on the front of the chest, like a pacemaker. For other uses see Pacemaker (disambiguation A pacemaker (or artificial pacemaker, so as not to be confused with the heart's natural pacemaker It can be programmed and the data examined using an external device that communicates with it by means of a radio signal.
Investigation of heart structure can also be important. The heart in most people with palpitations is completely normal in its physical structure, but occasionally abnormalities such as valve problems may be present. Usually, but not always, the cardiologist will be able to detect a murmur in such cases, and an echo scan of the heart (echocardiogram) will often be performed to document the heart's structure. An echocardiogram is a Sonography of the Heart. Also known as a cardiac ultrasound it uses standard ultrasound techniques to image two-dimensional slices of This is a painless test performed using sound waves and is virtually identical to the scanning done in pregnancy to look at the fetus. A fetus (or foetus or fœtus) is a developing Mammal or other Viviparous Vertebrate, after the Embryonic stage and
Treatment
Treating heart palpitations depends greatly on the nature of the problem. In many patients, caffeine intake triggers heart palpitations. In this case, treatment simply requires caffeine intake reduction. If it's been determined that caffeine is not the cause, another dietary consideration is too little magnesium, particularly in pre-menopausal women. A supplement of equal dosages of magnesium and calcium may be helpful in eliminating palpitations. For severe cases, medication is often prescribed.
A variety of medications manipulate heart rhythm, which can be used to try to prevent palpitations. If severe palpitations occur, a beta-blocking drug is commonly prescribed. Beta blockers (sometimes written as β-blocker) are a class of drugs used for various indications but particularly for the management of Cardiac arrhythmias These block the effect of adrenaline on the heart, and are also used for the treatment of angina and high blood pressure. Angina pectoris, commonly known as angina, is severe Chest pain due to Ischemia (a lack of blood and hence Oxygen supply of the heart However, they can cause drowsiness, sleep disturbance, depression, impotence, and can aggravate asthma. Other anti-arrhythmic drugs can be employed if beta-blockers are not appropriate.
If heart palpitations become severe, antiarrhythmic medication can be injected intravenously. If this treatment fails, cardioversion may be required. Synchronized electrical cardioversion is the process by which an abnormally fast Heart rate or Cardiac arrhythmia is terminated by the delivery of a therapeutic dose Cardioversion is usually performed under a short general anaesthesia, and involves delivering an electric shock to the chest, which stops the abnormal rhythm and allows the normal rhythm to continue. In modern medical practice general anaesthesia ( AmE: anesthesia) is a state of total unconsciousness resulting from General anaesthetic drugs
For some patients, often those with specific underlying problems found in ECG tests, an electrophysiological study may be advised. Electrophysiology (from Greek grc ἥλεκτρον ēlektron, "amber" the [[Electron#Etymology|etymology of "electron"]] grc φύσις This procedure involves inserting a series of wires into a vein in the groin, or the side of the neck, and positioning them inside the heart. Once in position, the wires can be used to record the ECG from different sites within the heart, and can also start and stop abnormal rhythms to further accurate diagnosis. If appropriate, i. e. if an electrical "short circuit" is shown to be responsible for the abnormal rhythm, then a special wire can be used to cut the "short circuit" by placing a small burn at the site. This is known as "radiofrequency ablation" and is curative in the majority of patients with this condition. Radio Frequency Ablation ( RFA) of Lung kidney breast bone and Liver tumors RFA is performed to cure tumors in lung liver kidney bone and rarely in other
Atrial fibrillation has been discussed in a separate article. Atrial fibrillation ( AF or afib) is a Cardiac arrhythmia (abnormal heart rhythm that involves the two upper chambers ( atria) of the Heart Treatment may include medication to control heart rate, or cardioversion to support normal heart rhythm. Patients may require medication after a cardioversion to maintain a normal rhythm. In some patients, if attacks of atrial fibrillation occur frequently despite medication, ablation of the connection between the atria and the ventricles (with implantation of a pacemaker) may be advised. A very important risk of atrial fibrillation is the increased risk of stroke. Management of atrial fibrillation usually includes some form of blood thinning treatment.
Very rarely, palpitations are associated with an increased risk of blackouts, and even premature death. Generally speaking, serious arrhythmias occur in patients who are known to have heart disease, or carry a genetic predisposition for heart disease or related abnormalities and complications.
Palpitations, in the setting of the above problems, or occurrences such as blackouts or near blackouts, should be taken seriously. Even if ultimately nothing is found, a doctor should be contacted immediately to arrange the appropriate investigations, especially if palpitations occur with blackouts or if any of the above conditions are noticed.
See also
- Electrocardiogram – graphic records of the electrical voltage in the heart
- Holter monitor – device monitoring electrical activity of the heart
- Tachycardia – an abnormally rapid beating of the heart
- Bradycardia – an abnormally slow beating of the heart
- Premature Ventricular Contraction – a form of irregular heartbeat
References
External links
- Abnormal Heart Rhythms, BHF
- British Heart Foundation
- Medic8 Family Health Guide
- MedlinePlus Medical Encyclopedia, NIH
Dictionary
palpitation
-noun
- An abnormal awareness of the beating of the heart, whether it is too slow, too fast, irregular, or at its normal frequency.
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